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To manage pain effectively in compliance with standards implemented by the Joint Commis-sion in January 2001, health care providers must assess for pain and routinely reassess to determine if interventions are working. Both staff and patients should be educated about the process to ensure assessments are performed correctly.
Patients at the University of Washington Medical Center in Seattle are given a pain management brochure explaining their right to have pain managed, but also the responsibility to participate in the process. Their participation includes asking for pain medication or a nonpharmacological intervention when pain is first detected, describing their pain, asking about pain management options, and alerting staff as to what interventions are working or not working. "We try to educate patients about the collaborative effort of pain management," says Joan Ching, RN, MN, a pain management clinical nurse specialist at the medical center.
The brochure has a brief description of the types of pain medications used and the nonpharmacological therapies that are available as well as examples of the three pain scales used at the facility. These include the numeric pain intensity scale of 0-10; a verbal rating scale with five adjectives — no pain, mild, moderate, severe and excruciating; and the Wong faces scale often used with pediatric patients that has faces with expressions from smiling to grimacing.
When patients are admitted to Grant/Riverside Methodist Hospitals in Columbus, OH, they are given a copy of the patient rights for pain and a teaching handout called "Describing Your Pain." Posters at the elevators reinforce the information with rights about pain assessment posted. (To learn how to assess pain when patients can’t participate, see "When patients can't participate, staff intercede," in this issue.)
On each unit, nurses review the information about pain scales and assessment, and a poster in the patient’s room depicts the pain scales. "If appropriate, the patient is provided with a pain diary when discharged," says Lisa Hartkopf Smith, RN, MS, AOCN, a clinical nurse specialist in pain management at the Riverside Methodist campus. The diary is used to record pain assessment information at home to be shared with health care professionals at future appointments or hospitalizations.
The handout "Describing Your Pain" explains that patients and their family are part of the pain management team, that patients are responsible for reporting their pain and the effectiveness of pain management and interventions, and the different pain scales used to assess pain. There’s also information on describing pain that prompts the patient to include its location, intensity, character, pattern, duration, aggravating and alleviating factors, associated symptoms, and the impact of pain on daily life such as sleep or social relationships, explains Hartkopf Smith.
Before patients even arrive at a health care facility, staff members must learn the pain assessment process and where to document pain. "The Joint Commission pain standards apply to any clinician or anyone who comes into direct patient contact. Therefore, when we did our housewide education we not only targeted nurses, but we educated physicians, physical therapists, social workers, radiology, and some unit assistants," says Ching.
The education included familiarizing staff with the pain standards and the standardized pain intensity tools used by the medical center, and teaching them about assessing for pain and documenting it. (To learn about the assessment and reassessment process, see "Get it to be an automatic question," in this issue.)
New employees that do not have direct patient contact are given a general overview of the importance of pain management and that it is a patient right during their initial orientation, but not taught how to do the assessment. It has not yet been determined how frequently staff will be re-educated or if pain management will be an annual staff training module.
All direct care providers at Grant/Riverside Methodist Hospitals receive a one-hour lecture on pain assessment and management in orientation and RNs receive three additional hours of pain content in orientation when they are hired, says Deb Jeffers, RN, IV/pain specialist at Grant/ Riverside Methodist Hospitals. When the pain management protocols were first initiated, existing staff attended mandatory inservices covering pain assessment and management.
A pain resource nurse program also is in place so that one RN on each unit serves as a resource on pain issues. These nurses also attend additional education programs on pain, says Jeffers.
To ensure that competency in pain management is kept at the forefront, it has been made part of an RN’s annual evaluation. If deficiencies are noted at that time, the RN must complete an additional education program, says Jeffers.
For more information about educating staff and patients about pain management, contact: